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Highlights from the MN HIV Surveillance Report, 2011

Highlights from the MN HIV Surveillance Report, 2011. Minnesota Department of Health HIV/AIDS Surveillance System. HIV/AIDS in Minnesota: New HIV Infection, HIV (non-AIDS) and AIDS Cases by Year, 1996-2011.

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Highlights from the MN HIV Surveillance Report, 2011

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  1. Highlights from the MN HIV Surveillance Report, 2011 Minnesota Department of Health HIV/AIDS Surveillance System

  2. HIV/AIDS in Minnesota:New HIV Infection, HIV (non-AIDS) and AIDS Cases by Year, 1996-2011 *Includes all new cases of HIV infection (both HIV (non-AIDS) and AIDS at first diagnosis) diagnosed within a given calendar year. ^Includes all new cases of AIDS diagnosed within a given calendar year, including AIDS at first diagnosis. This includes refugees in the HIV+ Resettlement Program, as well as, other refugee/immigrants diagnosed with AIDS subsequent to their arrival in the United States.

  3. As of December 31, 2011, 7,136* persons are assumed alive and living in Minnesota with HIV/AIDS 3,775 living with HIV infection (non-AIDS) 3,361 living with AIDS Estimated Number of PersonsLiving with HIV/AIDS in Minnesota * This number includes persons who reported Minnesota as their current state of residence, regardless of residence at time of diagnosis. Includes state prisoners and refugees arriving through the HIV+ Refugee Resettlement Program, as well as HIV+ refugee/immigrants arriving through other programs.

  4. HIV/AIDS in Minnesota:Number of Prevalent Cases, and Deaths by Year, 1996-2011 *Deaths among MN AIDS cases, regardless of location of death and cause. ^Deaths in Minnesota among people with HIV/AIDS, regardless of location of diagnosis and cause.

  5. HIV Infections† by County of Residence at Diagnosis, 2011 Kittson Roseau Lake of the Woods Marshall Koochiching Pennington Number of Infections Beltrami Cook Red Lake None Polk Lake St. Louis * Clearwater 1 - 2 Itasca Norman Mahnomen 3 - 6 Hubbard 7 - 15 Becker Cass Clay 16 - 54 * Aitkin Wadena Carlton 55 - 175 Crow Wing Wilkin Otter Tail City of Minneapolis – 101 City of St. Paul – 43 Suburban# – 107 Greater Minnesota - 41 Pine Todd Morrison Grant Douglas Kanabec Mille Lacs Traverse Benton * Stevens Pope Stearns Isanti * Total number = 292 Big Stone Sherburne Chisago * Swift Anoka * Wright Kandiyohi Meeker Washington Chippewa Ramsey Hennepin Lac qui Parle McLeod Carver * Yellow Medicine Renville *Counties in which a state correctional facility is located Dakota Scott Sibley * Lincoln * Lyon Redwood #7-county metro area, excluding the cities of Minneapolis and St. Paul Goodhue Le Sueur Nicollet Rice Wabasha Brown Pipestone Murray Blue Earth Cottonwood †HIV or AIDS at first diagnosis Waseca Steele Dodge Olmsted Winona Watonwan Rock Nobles Jackson Martin Faribault Fillmore Houston Freeborn Mower

  6. Map of Metro Area:HIV Infections† by County of Residence at Diagnosis, 2011 Number of Infections * Anoka None Washington 1 - 2 * 3 - 6 7 - 15 Hennepin Ramsey 16 - 54 55 - 175 City of Minneapolis – 101 City of St. Paul – 43 Suburban# – 107 Carver Total number (Metro only) = 251 Dakota * Scott * Counties in which a state correctional facility is located #7-county metro area, excluding the cities of Minneapolis and St. Paul

  7. HIV Infections* in Minnesota by Residence at Diagnosis, 2011 Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (except Minneapolis), Ramsey (except St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties, outside the seven-county metro area. * HIV or AIDS at first diagnosis

  8. Gender and Race/Ethnicity HIV/AIDS in Minnesota: Annual Review

  9. HIV Infections* by Gender andYear of Diagnosis, 1996 - 2011 * HIV or AIDS at first diagnosis

  10. HIV Infections* Diagnosed in Year 2011 and General Population in Minnesota by Race/Ethnicity * HIV or AIDS at first diagnosis † Population estimates based on 2010 U.S. Census data. n = Number of persons Amer Ind = American Indian Afr Amer = African American (Black, not African-born persons) Afr born = African-born (Black, African-born persons)

  11. Females (n = 74) Males (n = 218) HIV Infections* Diagnosed in Year 2011by Gender and Race/Ethnicity n = Number of persons Afr Amer = African American (Black, not African-born persons) Afr born = African-born (Black, African-born persons) Amer Ind = American Indian Other = Multi-racial persons or persons with unknown race * HIV or AIDS at first diagnosis

  12. Number of Cases and Rates (per 100,000 persons) of HIV Infection* by Race/Ethnicity† – Minnesota, 2011 * HIV or AIDS at first diagnosis; 2010 U.S. Census Data used for rate calculations. † “African-born” refers to Blacks who reported an African country of birth; “African American” refers to all other Blacks. Cases with unknown race are excluded. †† Estimate of 72,930 Source: Retrieved from MNCompass.org on 3/22/12. Additional calculations by the State Demographic Center. ^ Other = Multi-racial persons or persons with unknown race

  13. Mode of Exposure HIV/AIDS in Minnesota: Annual Review

  14. HIV Infections* Among Males by Modeof Exposure and Year of Diagnosis, 1996 - 2011 MSM = Men who have sex with men IDU = Injecting drug use Heterosexual = Heterosexual contact * HIV or AIDS at first diagnosis Unspecified = No mode of exposure ascertained

  15. HIV Infections* Among Females by Modeof Exposure and Year of Diagnosis, 1996 - 2011 IDU = Injecting drug use Heterosexual = Heterosexual contact with HIV+ , with IDU, with partner with unknown risk Unspecified = No mode of exposure ascertained * HIV or AIDS at first diagnosis

  16. Births to HIV-Infected Women and Number of Perinatally Acquired HIV Infections* by Year of Birth, 1996 - 2011 * HIV or AIDS at first diagnosis for a child exposed to HIV during mother’s pregnancy, at birth, and/or during breastfeeding.

  17. Special Populations HIV/AIDS in Minnesota: Annual Review

  18. Adolescents & Young Adults (Ages 13-24)* * Case numbers are too small to present meaningful data separately for adolescents and young adults. HIV/AIDS in Minnesota: Annual Review

  19. HIV Infections* Among Adolescents and Young Adults† by Gender and Year of Diagnosis, 1996 - 2011 * HIV or AIDS at first diagnosis †Adolescents defined as 13-19 year-olds; Young Adults defined as 20-24 year-olds.

  20. HIV Infections* Among Adolescents and Young Adults† by Gender and Race/Ethnicity, 2009 - 2011 Combined Males (n = 195) Females (n = 35) n = Number of persons Amer Ind = American Indian Afr Amer = African American (Black, not African-born persons) Afr born = African-born (Black, African-born persons) Other = Multi-racial persons or persons with unknown race * HIV or AIDS at first diagnosis †Adolescents defined as 13-19 year-olds; Young Adults defined as 20-24 year-olds.

  21. HIV Infections* Among Adolescents and Young Adults† by Gender and Estimated Exposure Group#,2009 - 2011 Combined Males (n = 195) Females (n = 35) * HIV or AIDS at first diagnosis †Adolescents defined as 13-19 year-olds; Young Adults defined as 20-24 year-olds. # Mode of Exposure proportions have been estimated using cases for 2009-2011 with known risk. For more detail see the HIV Surveillance Technical notes. n = Number of persons MSM = Men who have sex with men IDU = Injecting drug use Heterosex = Heterosexual contact

  22. HIV and Hepatitis B, C co-infection

  23. As of December 31, 2011* , 7,136 persons are assumed alive and living in Minnesota with HIV/AIDS Of these 7,136 persons, 855 (12%) are co-infected with either Hepatitis B or C Of the 855, 288 (34%) are living with HIV and Hep B Of the 855, 523 (62%) are living with HIV and Hep C Of the 855, 44 (5%) are living with HIV, Hep B and Hep C HIV and Hepatitis B and C * This number includes persons who reported Minnesota as their current state of residence, regardless of residence at time of diagnosis. Includes state prisoners and refugees arriving through the HIV+ Refugee Resettlement Program, as well as, HIV+ refugee/immigrants arriving through other programs. Data Sources: Minnesota HIV/AIDS Surveillance System and Minnesota Hepatitis Surveillance System

  24. Foreign-born Cases HIV/AIDS in Minnesota: Annual Review

  25. HIV Infections* among Foreign-Born Persons†in Minnesota by Year of Diagnosis and Region of Birth, 1996 - 2011 Region of Birth# * HIV or AIDS at first diagnosis † Excludes persons arriving to Minnesota through the HIV+ Refugee Resettlement Program, as well as other refugee/immigrants with an HIV diagnosis prior to arrival in Minnesota. # Latin America/Car includes Mexico and all Central, South American, and Caribbean countries.

  26. HIV Infections* Among Foreign-Born Persons† by Gender and Year of Diagnosis, 1996 – 2011 • HIV or AIDS at first diagnosis • † Excludes persons arriving in Minnesota through the HIV+ Refugee Resettlement Program, as well as, other refugee/immigrants with an HIV diagnosis prior to arrival in Minnesota.

  27. HIV Infections* Among Foreign-Born Persons†by Gender and Age, 2011 * HIV or AIDS at first diagnosis † Excludes persons arriving to Minnesota through the HIV+ Refugee Resettlement Program, as well as other refugee/immigrants with an HIV diagnosis prior to arrival in Minnesota.

  28. Countries of Birth Among Foreign-Born Persons† Diagnosed with HIV*, Minnesota, 2011 • Mexico (n=12) • Kenya (n=11) • Liberia (n=10) • Somalia (n=7) • Ethiopia (n=5) • Viet Nam (n=3) • Other^ (n=21) * HIV or AIDS at first diagnosis † Excludes persons arriving to Minnesota through the HIV+ Refugee Resettlement Program, as well as other refugee/immigrants with an HIV diagnosis prior to arrival in Minnesota. ^ Includes 18 additional countries.

  29. Late Testers (AIDS Diagnosis within one year of initial HIV Infection Diagnosis) HIV/AIDS in Minnesota: Annual Review

  30. Time of Progression to AIDS for HIV Infections Diagnosed in Minnesota*, 2001 - 2011† 29.3%^ 30.9%^ 33.2%^ 32.0%^ 29.8%^ 33.7%^ 30.6%^ 41.2%^ 30.5%^ 35.6%^ 35.4%^ *Numbers include AIDS at 1st report but exclude persons arriving to Minnesota through the HIV+ Refugee Resettlement Program, as well as other refugee/immigrants with an HIV diagnosis prior to arrival in Minnesota. ^ Percent of cases progressing to AIDS within one year of initial diagnosis with HIV Infection. † Numbers/Percent for cases diagnosed in 2011 only represents cases progressing to AIDS through April 2, 2012.

  31. Progression to AIDS within 1 year of initial HIV Infection* Diagnosis by Gender, 2001 - 2011† *Numbers include AIDS at 1st report but exclude persons arriving to Minnesota through the HIV+ Refugee Resettlement Program, as well as other refugee/immigrants with an HIV diagnosis prior to arrival in Minnesota. † Numbers/Percent for cases diagnosed in 2011 only represents cases progressing to AIDS through April 2, 2012.

  32. Progression to AIDS within 1 year of initial HIV Infection* Diagnosis by Race/Ethnicity^, 2001 - 2011† *Numbers include AIDS at 1st report but exclude persons arriving to Minnesota through the HIV+ Refugee Resettlement Program, as well as other refugee/immigrants with an HIV diagnosis prior to arrival in Minnesota. † Numbers/Percent for cases diagnosed in 2011 only represents cases progressing to AIDS through April 2 2012. ^Percentage not calculated if less than 10 cases diagnosed per year

  33. Time of Progression to AIDS for HIV Infections* Diagnosed Among Foreign-Born Persons, Minnesota 2001 - 2011† 40.6%^ 41.4%^ 59.3%^ 44.0%^ 47.4%^ 42.5%^ 42.7%^ 40.3%^ 49.2%^ 43.6%^ 48.3%^ *Numbers include AIDS at 1st report but exclude persons arriving to Minnesota through the HIV+ Refugee Resettlement Program, as well as other refugee/immigrants with an HIV diagnosis prior to arrival in Minnesota. ^ Percent of cases progressing to AIDS within one year of initial diagnosis with HIV Infection. † Numbers/Percent for cases diagnosed in 2011 only represents cases progressing to AIDS through April 2, 2011.

  34. Conclusions • There were 292 new HIV infections reported in MN in 2011 • A decrease of 12 percent from 2010 • Great disparities in HIV infection persist among populations of color and American Indians living in Minnesota • Male-to-male sex remains the leading risk factor for acquiring HIV/AIDS in MN • New HIV infection remains concentrated in the Twin Cities seven-county metro area (86% of new infections in 2011) • Foreign-born persons made up nearly 1 in 4 of new HIV infections in 2011, and progress from HIV to AIDS more quickly than U.S. born persons living with HIV in Minnesota

  35. For more information, please contact: Allison La Pointe, HIV/AIDS Surveillance Coordinator allison.lapointe@state.mn.us (651) 201-4032

  36. Hepatitis A, B & C in Minnesota, 2011 Minnesota Department of Health Hepatitis Surveillance System

  37. Communicable Disease Reporting – HIV & Hepatitis • Hepatitis A, B, C, D and E, HIV and AIDS are all reportable by name to the Minnesota Department of Health (MDH). • All reported cases may be contacted by the MDH Surveillance staff for epidemiological follow-up.

  38. Minnesota Hepatitis Surveillance System • Hepatitis B reportable since 1987 • Hepatitis C reportable since 1998 • Passive data collection

  39. Introduction • Data in this presentation are current through 2011 • Definitions: • Acute case: • Infected within the last six months • Symptomatic • Chronic case: • Infected for over six months • Asymptomatic or symptomatic • Resolved cases: • No evidence of current infection • Evidence of past infection

  40. Data limitations • The slides rely on data from HCV and HBV cases diagnosed through 2011 and reported to the Minnesota Department of Health (MDH) Hepatitis Surveillance System. • Some limitations of surveillance data: • Data do not include hepatitis-infected persons who have not been tested • Data do not include persons whose positive test results have not been reported to the MDH • Persons are assumed to be alive unless the MDH has knowledge of their death. • Persons whose most recently reported state of residence was Minnesota are assumed to be currently residing in Minnesota unless the MDH has knowledge of their relocation.

  41. Acute Viral Hepatitis • Acute case: • Infected within the last six months • Symptomatic

  42. Reported rate per 100,000 population of acute viral hepatitisUnited States, 1998-2009 Data Source: Surveillance for Acute Viral Hepatitis --- United States, 2007, May 22, 2009 / 58(SS03);1-27

  43. Number of Acute Cases per year Minnesota,1998-2011 Data Source: MN Viral Hepatitis Surveillance System

  44. Chronic Viral Hepatitis

  45. Overview of HCV in Minnesota A hepatitis C case is defined as current or past infection with hepatitis C and includes: • Acute cases: • Infected within the last six months • Symptomatic • Chronic cases: • Infected for over six months • Resolved cases: • No evidence of current infection • Evidence of past infection

  46. Reported Number of PersonsLiving with HCV in MN • As of December 31, 2011, 37,303* persons are assumed alive and living in MN with HCV *Includes persons with unknown city of residence Note: Includes all acute, chronic, probable chronic, and resolved cases. Data Source: MN Viral Hepatitis Surveillance System

  47. HCV Infected Persons Identified through Passive Surveillance in MN through 2011 N=84,863** 37,303 HCV infected persons* identified through passive surveillance Estimated unidentified HCV infected persons 47,560 *Includes all acute, chronic, probable chronic, and resolved cases. **http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm Data Source: MN Viral Hepatitis Surveillance System

  48. Persons Living with HCV in MN by Current Residence, 2011 Total number with residence information= 35,883 (1420 missing residence information) Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (except Minneapolis), Ramsey (except St. Paul), Scott, and Washington counties including those in Hennepin County or Ramsey County with unknown city. Greater MN = All other Minnesota counties, outside the seven-county metro area. Data Source: MN Viral Hepatitis Surveillance System

  49. Persons Living with HCV in MN by Age, 2011 Median Age: 55 Data Source: MN Viral Hepatitis Surveillance System

  50. Persons Living HCV in MN by Gender*, 2011 *Includes anonymous methadone patients Data Source: MN Viral Hepatitis Surveillance System

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